Kidney Week

Abstract: FR-PO767

In-Vivo Dialysis Kinetics of 300 mL/min and 500 mL/min Dialysate Flows

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Augustin, Dimitri A., Stanford University School of Medicine, Palo Alto, California, United States

Dimitri A. Augustin,

• Spry, Leslie A., Unafilliated, Lincoln, Nebraska, United States

Leslie A. Spry,

• Prichard, Sarah S., Unafilliated, Montreal, Quebec, Canada

Sarah S. Prichard,

• Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Glenn Matthew Chertow,

• Alvarez, Luis, Palo Alto Medical Foundation, Palo Alto, California, United States

Luis Alvarez,

Background

Conventional dialysate flow rates (Q_D) are typically 500-800ml/min with the intent to maximize urea removal during hemodialysis. We previously conducted kinetic modeling of 300 ml/min compared to 500 ml/min (Q_D) and concluded that lower Q_D would be expected to provide adequate hemodialysis. Little is known about the kinetics of dialysis with a 300 ml/min (Q_D) since the bulk of literature focuses on (Q_D) above 500ml/min. We present in-vivo kinetic testing of hemodialysis patients with 500ml/min and 300ml/min (Q_D) and evaluate the differences in kinetic curves.

Methods

The study group included 6 patients undergoing chronic hemodialysis via a fistula (n=4) or graft (n=2). Mean age was 58 years; mean weight was 85kg. We performed a prospective, open label, randomized, cross-over evaluation of in-vivo kinetics of serum urea, phosphorus, and other solutes at variable (Q_D). All patients participated in 2 complete dialysis sessions in each of 3 treatment conditions: 1. 500ml/min (Q_D), 2. 300ml/min (Q_D), and 3. 300ml/min (Q_D) with extended time.

Results

The mean urea kinetic curves with (Q_D) 300ml/min and 500ml/min mirrored each other in all 6 patients. The figure displays data for the 3 patients with 240 minutes prescriptions. The inverted curves include an initial steep decline and gradual trough at the end of hemodialysis treatment; the curves conclude with a slight rebound curve within an hour post treatment. Mean serum beta₂ microglobulin, bicarbonate, potassium, phosphate, and sodium all followed similar kinetic curves during Q_D 300ml/min and 500ml/min.

Conclusion

With a fixed dialyzer size and blood flow rate, solute kinetics of 300 ml/min (Q_D) are similar to those of a 500 ml/min (Q_D).

Funding

• Commercial Support –